Impact of radiation techniques on lung toxicity in patients with mediastinal Hodgkin’s lymphoma

Abstract Purpose Mediastinal radiotherapy (RT), especially when combined with bleomycin, may result in substantial pulmonary morbidity and mortality. The use of modern RT techniques like intensity-modulated radiotherapy (IMRT) is gaining interest to spare organs at risk. Methods We evaluated 27 patients who underwent RT for Hodgkin’s lymphoma between 2009 and 2013 at our institution. For each patient, three different treatment plans for a 30-Gy involved-field RT (IFRT) were created (anterior-posterior-posterior-anterior setup [APPA], 5‑field IMRT, and 7‑field IMRT) and analyzed concerning their inherent “normal tissue complication probability” (NTCP) for pneumonitis and secondary pulmonary malignancy. Results The comparison of different radiation techniques showed a significant difference in favor of standard APPA (p < 0.01). The risk of lung toxicity was significantly higher in plans using 7‑field IMRT than in plans using 5‑field IMRT. The absolute juxtaposition showed an increase in risk for radiation pneumonitis of 1% for plans using 5‑field IMRT over APPA according to QUANTEC (Quantitative Analyses of Normal Tissue Effects in the Clinic) parameters (Burman: 0.15%) and 2.6% when using 7‑field IMRT over APPA (Burman: 0.7%) as well as 1.6% when using 7‑field IMRT over 5‑field IMRT (Burman: 0.6%). Further analysis showed an increase in risk for secondary pulmonary malignancies to be statistically significant (p < 0.01); mean induction probability for pulmonary malignoma was 0.1% higher in plans using 5‑field IMRT than APPA and 0.19% higher in plans using 7‑field IMRT than APPA as well as 0.09% higher in plans using 7‑field IMRT than 5‑field IMRT. During a median follow-up period of 65 months (95% confidence interval: 53.8–76.2 months), only one patient developed radiation-induced pneumonitis. No secondary pulmonary malignancies have been detected to date. Conclusion Radiation-induced lung toxicity is rare after treatment for Hodgkin lymphoma but may be influenced significantly by the RT technique used. In this study, APPA RT plans demonstrated a decrease in potential radiation pneumonitis and pulmonary malignancies. Biological planning using NTCP may have the potential to define personalized RT strategies

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A review on the dosimetrical and radiobiological prediction of radiation-induced hypothyroidism in radiation therapy of head-and-neck cancer, breast cancer, and Hodgkin’s lymphoma survivors

Polish Journal of Medical Physics and Engineering ◽

10.2478/pjmpe-2018-0020 ◽

2018 ◽

Vol 24 (4) ◽

pp. 137-148

Author(s):

Aysan Mohammad Namdar ◽

Mohammad Mohammadzadeh ◽

Murat Okutan ◽

Asghar Mesbahi

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Head And Neck ◽

Hodgkin’S Lymphoma ◽

Normal Tissue Complication Probability ◽

Hodgkin's Lymphoma ◽

Cancer Breast ◽

Treatment Plans ◽

Radiation Induced ◽

Pre Treatment

Abstract A review on the radiobiological modeling of radiation-induced hypothyroidism after radiation therapy of head-and-neck cancers, breast cancer, and Hodgkin’s lymphoma is presented. The current review is based on data relating to dose-volume constrains and normal tissue complication probability (NTCP) as a function of either radiobiological or (pre)treatment-clinical parameters. Also, these data were explored in order to provide more helpful criteria for radiobiological optimization of treatment plans involving thyroid gland as a critical normal organ.

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A New Paradigm for Radiation-Induced Toxicity Analysis: Space Based Normal Tissue Complication Probability Modeling

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.06.249 ◽

2018 ◽

Vol 102 (3) ◽

pp. S96-S97

Author(s):

G. Palma ◽

A. Buonanno ◽

S. Monti ◽

R. Pacelli ◽

L. Cella

Keyword(s):

Normal Tissue ◽

Normal Tissue Complication Probability ◽

New Paradigm ◽

Probability Modeling ◽

Toxicity Analysis ◽

Radiation Induced

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Transition from conformal to advanced radiotherapy techniques in treatment planning of gynecological cancer patients

Vojnosanitetski pregled ◽

10.2298/vsp210520077p ◽

2021 ◽

pp. 77-77

Author(s):

Borislava Petrovic ◽

Olivera Ivanov ◽

Milana Marjanovic ◽

Jelena Licina ◽

Ivan Gencel ◽

...

Keyword(s):

At Risk ◽

Cancer Patients ◽

Maximum Dose ◽

Organs At Risk ◽

Gynecological Cancer ◽

Conformal Radiation Therapy ◽

Significant Difference ◽

Treatment Plans ◽

Radiation Induced ◽

Risk Treatment

Background/ Aim. Transition from standard to highly conformal radiation therapy techniques, requires implementation of complex advanced dosimetry. The aim of the work was comparison of dosimetric parameters of 3DCRT and VMAT plan, as well as complications after treatment in relation to dosimetric parameters at gynecological cancer patients. Methods. Forty-nine gynecological cancer patients were included in the study. All patients were planned for 3D CRT, but due to unacceptable doses to organs at risk, treatment plans for IMRT or VMAT were generated for 21 patients. The patients were prescribed 50.4 Gy/28 fractions (4) and 45 Gy/25 fractions (45 patients). The coverage of PTV and doses to organs at risk were recorded. PTV margins were evaluated for both techniques according to the Van Herk formula. Results. ICRU 83 criteria were fulfilled in all 3DCRT /VMAT/IMRT plans providing optimal coverage of PTV. Doses to OARS: in average, the V45Gy in small bowel in IMRT/VMAT plans was four times smaller than the same of 3DCRT plans. The V45Gy of small bowels was in average 49.4cm3 in IMRT/VMAT plans, while in 3DCRT plans it was 211.6 cm3. In case of femoral head, significant reduction in V30Gy (10.8 % vs. 33.1%) and mean dose in case of IMRT/VMAT plans was recorded (30.4 Gy in 3DCRT vs 23.6 Gy). Rectum was planned with significantly lower dose in terms of V30Gy (79.5% vs 95.2%) in IMRT/VMAT plans. Bladder was better spared in VMAT plans in terms of V40Gy (51% vs. 91%), but maximum dose was higher in VMAT plans than in 3DCRT (50.1 Gy to 48.1 Gy in average). For all OARs there is statistically significant difference registered at p>0.05. Toxicities recorded in VMAT and 3DCRT patients include mainly radiation induced cystitis and enteritis. Patients treated with 3DCRT generally have longer recovery time. Homogeneity index was 0.11 for VMAT plans and 0.09 for 3DCRT plans. Conclusions. Analysis of dosimetric parameters revealed significant differences in normal tissue doses for same 3DCRT and VMAT patient, which confirmed necessity for implementation of advanced techniques for as many patients as possible.

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Assessing the uncertainty in a normal tissue complication probability difference (∆NTCP): radiation-induced liver disease (RILD) in liver tumour patients treated with proton vs X-ray therapy

Journal of Radiation Research ◽

10.1093/jrr/rry018 ◽

2018 ◽

Vol 59 (suppl_1) ◽

pp. i50-i57 ◽

Cited By ~ 2

Author(s):

Keiji Kobashi ◽

Anussara Prayongrat ◽

Takuya Kimoto ◽

Chie Toramatsu ◽

Yasuhiro Dekura ◽

...

Keyword(s):

Liver Disease ◽

Normal Tissue ◽

Normal Tissue Complication Probability ◽

Liver Tumour ◽

X Ray ◽

Radiation Induced

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TH-C-213AB-06: Risk of Radiation-Induced Cardiotoxicity and Secondary Cancers in Hodgkin's Lymphoma Patients

Medical Physics ◽

10.1118/1.4736295 ◽

2012 ◽

Vol 39 (6Part30) ◽

pp. 3994-3994

Author(s):

A Toltz ◽

N Shin ◽

C Laude ◽

D Roberge ◽

C Freeman ◽

...

Keyword(s):

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Secondary Cancers ◽

Radiation Induced

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Non-Hodgkin's Lymphoma in the Elderly: A Retrospective Evaluation of Toxicity Related to Aggressive vs. Conservative Treatments

Tumori Journal ◽

10.1177/030089168807400410 ◽

1988 ◽

Vol 74 (4) ◽

pp. 433-438 ◽

Cited By ~ 3

Author(s):

Umberto Tirelli ◽

Vittorina Zagonel ◽

Rachele Volpe ◽

Mauro G. Trovo ◽

Antonino Carbone

Keyword(s):

Elderly Patients ◽

Hodgkin’S Lymphoma ◽

Randomized Trials ◽

Survival Rates ◽

The Elderly ◽

Hodgkin's Lymphoma ◽

Severe Toxicity ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Significant Difference

The outcome of 70 elderly patients aged 65 years or more (median, 71 years) with non-Hodgkin's lymphoma (NHL) treated between 1973 and 1981 with aggressive (AM) or conservative modalities (CM) was retrospectively evaluated. A significantly higher incidence of lethal and severe toxicity was observed in patients treated with AM than in those treated with CM (32 % vs 3 %, p < 0.01), with 10 % treatment related deaths in the AM group. Only 56 % of the deaths were attributed to NHL; other major causes were treatment-related deaths, infection and cardiac diseases. No significant difference in response and survival was found between AM and CM groups (complete remission rates were 35 % vs 42 %, and 10 year survival rates were 31 % vs 19 %, respectively), but the prevalence of stages III-IV in patients treated with AM makes these results meaningless. Prospective randomized trials with AM vs CM are clearly needed in elderly patients with advanced unfavorable NHL.

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Evaluation of neutropenia-related outcomes in Hodgkin's lymphoma patients with moderate or severe neutropenia who received ABVD chemotherapy without using granulocyte-colony stimulating factor

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155219891663 ◽

2019 ◽

Vol 26 (4) ◽

pp. 929-932

Author(s):

Alparslan Merdin ◽

Merih Kızıl Çakar ◽

Mehmet Sinan Dal ◽

Duygu Mert ◽

Jale Yıldız ◽

...

Keyword(s):

Neutrophil Count ◽

Significant Relationship ◽

Hodgkin’S Lymphoma ◽

Lung Toxicity ◽

Hodgkin's Lymphoma ◽

Severe Neutropenia ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Stimulating Factor ◽

Abvd Chemotherapy

Objective To evaluate the possible neutropenia-related effects of administering adriamycin [doxorubicin], bleomycin, vinblastin, dacarbazine (ABVD) chemotherapy in Hodgkin’s lymphoma patients with moderate or severe neutropenia without granulocyte-colony stimulating factor supplementation. Methods This study evaluated neutropenia-related outcomes and the need for granulocyte-colony stimulating factor use during the periods between chemotherapy rounds. Forty-three rounds of ABVD chemotherapy were evaluated in the study. The outcomes that could be related to neutropenia were analyzed. In addition, rounds of ABVD chemotherapy given in the presence of severe neutropenia were compared with ABVD chemotherapy rounds given in the presence of moderate neutropenia in terms of neutropenia-related outcomes and the need for granulocyte-colony stimulating factor use. The study only included patients with classical Hodgkin's disease (lymphoma). Patients with a final neutrophil count of <1 × 103 cells/µL (<1000 cells/µL) prior to chemotherapy round and those receiving ABVD chemotherapy for Hodgkin’s lymphoma were included in the study. Results We observed that none of the patients with moderate neutropenia before the start of chemotherapy round needed granulocyte-colony stimulating factor, and four patients with severe neutropenia prior to the start of chemotherapy round required granulocyte-colony stimulating factor. However, there was no statistically significant relationship between the severity of neutropenia (in terms of moderate and severe) before chemotherapy and granulocyte-colony stimulating factor requirement after chemotherapy (p> 0.05). Furthermore, none of the patients included in the study had bleomycin-related lung toxicity during the treatment periods included in the study. Conclusion Administering ABVD chemotherapy to patients with moderate neutropenia seems to be safe.

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Cytodiagnostic Sensitivity of Fine Needle Aspiration Biopsy for Hodgkin’s Lymphoma Is Decreased in Patients with Human Immunodeficiency Virus Infection

Acta Cytologica ◽

10.1159/000501098 ◽

2019 ◽

Vol 63 (5) ◽

pp. 352-360 ◽

Cited By ~ 1

Author(s):

Adam J. Perricone ◽

Mohammad K. Mohammad ◽

Rachel L. Geller ◽

Marina B. Mosunjac

Keyword(s):

Fine Needle Aspiration ◽

Hodgkin’S Lymphoma ◽

Needle Aspiration ◽

Diagnostic Sensitivity ◽

Hodgkin's Lymphoma ◽

P Value ◽

Hiv Patients ◽

Female Ratio ◽

Fine Needle ◽

Significant Difference

Objective: We aimed to evaluate the sensitivity of fine needle aspiration (FNA) for the diagnosis of Hodgkin’s lymphoma (HL) in HIV-infected patients. Study Design: An electronic search was conducted to retrospectively identify patients diagnosed with HL who underwent FNA followed by confirmatory biopsy. FNAs were categorized as negative, atypical/suspicious/positive, or nondiagnostic. Diagnostic sensitivity in HIV+ and HIV– patients was statistically compared via Fisher’s exact test, with a p value <0.05 considered significant. Results: Thirty-six patients meeting inclusion criteria were identified (24 HIV– and 12 HIV+). Average age was 36.0 ± 11.5 and 36.5 ± 7.4 years (means ± SD) in HIV– and HIV+ patients, respectively. The male-to-female ratio was 1.4:1 in HIV– patients versus 3:1 in HIV+ patients. Among these 36 patients, a total of 42 FNAs were performed. Overall sensitivity of FNA was 66.7% (95% confidence interval: 52.4–80.9%). When stratified by HIV status, a statistically significant difference in FNA sensitivity was detected, as sensitivity was 84.6% (70.8–98.4%) in HIV– patients versus only 37.5% (13.8–61.2%) in HIV+ patients (p =0.003). Conclusion: The diagnostic sensitivity of FNA biopsy was significantly attenuated in the HIV+ cohort. In HIV-infected patients presenting with lymphadenopathy, increased clinical suspicion of HL is critical to avoid misdiagnosis.

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